Camperdown Academy Camp Creekside Application 2026
June 8 - July 17, excluding the week of June 29 - July 3
Camper's Name
*
First Name
Last Name
Name camper would prefer to be known as (if different from first name)
Parent Information
Parent/Guardian #1
*
First Name
Last Name
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #1 Phone Number
*
Please enter a valid phone number.
Parent/Guardian #1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to add information for another parent/guardian?
*
Yes
No
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Parent/Guardian #2 Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
*
First Name
Last Name
Relationship to Camper
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper Information
Gender
*
Female
Male
Birthdate
*
-
Month
-
Day
Year
Date
Does your child currently attend Camperdown Academy?
*
Yes
No
Current school
*
Current teacher's email address. We will email the teacher a student questionnaire.
*
Rising Grade (26-27 school year)
*
Please Select
1st
2nd
3rd
4th
5th
6th
Returning camper?
*
Yes
No
T-shirt size
*
Please Select
Youth small
Youth medium
Youth large
Youth x-large
Adult Small
Adult Medium
Adult Large
Health Information
Does your child have a pyscho-educational evaluation or current IEP?
*
Yes
No
If yes, please upload.
*
Browse Files
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Choose a file
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of
Has your child had a speech and language assessment?
*
Yes
No
If yes, please upload.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your child's most recent standardized testing (i.e. MAP, STAR...)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Allergies and reaction (if no, type n/a)
*
Any additional medical information you wish Camp Creekside staff to know?
*
Medication, Dosage, and Time.
*
Last Diptheria/Tetanus/Tetanus booster
*
-
Month
-
Day
Year
Date
I give permission for camp personnel to administer first aid or over-the-counter medication as necessary.
*
Yes
No
I give permission for camp personnel to order necessary treatment in the event of a medical emergency.
*
Yes
No
Medical Insurance Carrier
*
Policy Number
*
Insured Name
*
Primary Care Provider
*
Primary Care Provider Phone Number
*
Dentist
*
Dentist Phone Number
*
Parent Questionnaire
Please share your child's strengths and weaknesses.
*
Please share your child's greatest academic need(s)?
*
What does your child like to do for fun?
*
How did you learn about us?
*
Current Camperdown Academy Family
Friend or Family Member
Social Media
Camperdown Website
Internet Search
Advertising (Upstate Parents, Kidding Around Greenville...)
Psychologist
Other
I consent to my child being included in photography/videography taken during the course of summer camp for publicity, promotional, or educational purposes.
*
Yes
No
Name & relationship of those who can pick up your child from Camp Creekside.
*
Please read our Camp Creekside 2026 Summer Application Procedures and Policies.
I agree to the Camp Creekside 2026 Summer Application Procedures and Policies.
*
I would like to enroll my child in early-stay for a one-time fee of $100.
Yes
No
Camp Creekside Deposit
*
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Camp Creekside Deposit
$
500.00
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